Considering More Than Consequences in the Classroom Merging Applied Behavior Analysis with Sensory a

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Considering More Than Consequences in the
Classroom Merging Applied Behavior Analysis
with Sensory and Communication Based
StrategiesJames Ball, EdD, BCBADenise Sawan
Caruso, MAChris Filler, BSN, RNAutism Society
of America National ConferenceFlorida July, 2008
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Direct InstructionTeaching MethodologybyJames
Ball, EdD, BCBABehavior Consultant
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Sd - Prompt - R - C - M - II

• Sd Cue
• Prompt
• Response
• Consequence
• Measurement
• Inter-trial Interval

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DISCRIMINATIVE
STIMULUS (SD)
1.)
Direction
2.) Present one time

3.) Wait 5 7 seconds STUDENTS
RESPONSE CORRECT
INCORRECT OR
NO RESPONSE TEACHERS
CONSEQUENCE REINFORCEMENT
CORRECTION 1.) Primary (food)
1.) Prompt 2.) Secondary
(praise) 2.) Teach
3.) Praise only
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Prompting

• Physical
• Modeling
• Gestural
• Verbal
• Signed
• Locational
• Positional

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Reinforcement

• Primary
• Secondary

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Secondary Reinforcers

• Social
• Activity
• Token
• Covert

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Satiation
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Negative Reinforcement
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• DRO
• DRL
• DRI
• DRA

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Procedures for Utilizing Reinforcers

• Fixed Ratio
• Fixed Interval
• Mixed Ratio
• Mixed Interval

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Applied Behavior Analysis a discipline devoted
to understanding and improving human behavior

• Applied focuses on the implementation of basic
  principles to behaviors of significance to those
  involved
• Behavior focuses on behavior as a target of
  change
• Analysis seeks to identify the functional
  relationship between behavior and environmental
  events

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ABA ?

• Is socially important
• Is data based
• Can be replicated
• Is analytical
• Recognizes the power of positive reinforcement
• Is highly individualized
• Includes ongoing assessment
• Includes proactive and reactive strategies
• Addresses both skill acquisition and behavior
  reduction
• Emphasizes generalization and maintenance of
  skills

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What You Need

• Functional Communication System
• Individualized Reinforcement System

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Behavioral Treatment Guidelines

• Define the Behavior
• Collect Data
• Do an FBA
• Establish a Hypothesis
• Test that Hypothesis
• Review the Data for Effectiveness

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Assessment

• Environmental
• Medical
• Curricular

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Assessment, Assessment, Assessment

• Eden Decision Model (EDM)
• Functional Analysis Screening Tool (FAST)
• Specific Learning Disabilities (SLD) Behavior
  Checklist
• Functional Skills Inventory

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Function of Behavior

• Communication
• Tangible
• Obsessive/Compulsive
• Self Stimulation
• Escape/Avoidance
• Attention Seeking

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Develop the Program

• Based on the FBA
• Determine the Course of Action
• Develop the Behavior Intervention Plan
• Develop the Alternative Teaching Program
• Take Data to Evaluate

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Teaching New Skills

• Functionally Equivalent Skills
• Functionally Related skills

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Issues with Current Models of Antecedent/Behavior/
Consequent Data Collection

• Predictability
• Reliability
• Ability to Verify Results

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• Sensory Processing Challenges
  Implications to Behavior Skill
  Development
• Considerations for Sensory Interventions
• Chris Filler
• OCALI Transition Coordinator

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Behavioral Effects

• Sensory Processing challenges can influence how
  students respond to
• Environment
• People
• Instruction/Tasks/Activities
• Understanding these influences leads to the
  selection of effective interventions

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What is Sensory Processing?

• A Process by which we

1. Take in Information
2. Interpret the Information
3. Develop a Response or Action
1
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Sensory Processes

• Sensory Processes include
• Sound/Auditory
• Sight/Vision
• Smell/Olfactory
• Taste/Gustatory
• The Power Senses
• Touch/Tactile
• Vestibular
• Proprioception

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Breakdowns

• Breakdown may occur at any point
• Challenges to the intake system are more easily
  recognized
• Faulty operation of the interpretation and
  integration of information may be seen as a
  behavioral issue
• Negative consequences may only make the situation
  worse

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Summary of Processing Challenges
SEEKER Heightened Awareness with Low Sensitivity
to Stimulation Will Seek Out Input (Frequently
and Intensively Moving, Jumping, Spinning,
Touching)
UNDER-RESPONDER Poor Awareness Low
Sensitivity to Stimulation. Misses Environmental
Cues Slow Processing (Acts as if does not hear,
misses gestures and cues, sedentary)
ACTIVE AVOIDER High Awareness, with High
Sensitivity and Active Responses. Will actively
avoid (Searching out Escape Areas, Covering
ears/eyes, Aggression to Protect self)
OVERWHELMED Heightened awareness, High
Sensitivity but lacks active response, Can
become easily overwhelmed. ( Complains of things
bothering Frequently anxious/upset, overreacts
to small changes in the environment)
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SEEKER Heightened Awareness with Low Sensitivity
to Stimulation Will Seek Out Input (Frequently
and Intensively Moving, Jumping, Spinning,
Touching)

• Seeker and Active Avoider
  can appear similar
• Both may move frequently
• Seekers are looking for the stimulation
• Avoiders are attempting to escape the stimulation

ACTIVE AVOIDER High Awareness, with High
Sensitivity and Active Responses. Will actively
avoid (Searching out Escape Areas, Covering
ears/eyes, Aggression to Protect self)
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UNDER-RESPONDER Poor Awareness Low
Sensitivity to Stimulation. Misses Environmental
Cues Slow Processing (Acts as if does not hear,
misses gestures and cues, sedentary)

• Under-Responder and Overwhelmed
  can also have some similarities
• May not appear as sensory needy as the
  seeker/avoider
• Overwhelmed are vigilant and will have anxiety to
  the environment and will resist change
• Under-responders also may not respond to
  environmental cues, however due to lack of
  awareness and not vigilance

OVERWHELMED Heightened awareness, High
Sensitivity but lacks active response, Can
become easily overwhelmed. ( Complains of things
bothering Frequently anxious/upset, overreacts
to small changes in the environment)
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Summary of Processing Challenges
SEEKER Heightened Awareness with Low Sensitivity
to Stimulation Will Seek Out Input (Frequently
and Intensively Moving, Jumping, Spinning,
Touching)
UNDER-RESPONDER Poor Awareness Low
Sensitivity to Stimulation. Misses Environmental
Cues Slow Processing (Acts as if does not hear,
misses gestures and cues, sedentary)
ACTIVE AVOIDER High Awareness, with High
Sensitivity and Active Responses. Will actively
avoid (Searching out Escape Areas, Covering
ears/eyes, Aggression to Protect self)
OVERWHELMED Heightened awareness, High
Sensitivity but lacks active response, Can
become easily overwhelmed. ( Complains of things
bothering Frequently anxious/upset, overreacts
to small changes in the environment)
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The "Sensory Diet"
So What Can We Do?
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The Sensory Diet includes.

• PROVIDING SENSORY EXPERIENCES
• A combination of sensory experiences needed by a
  person to adaptively interact with the
  environment (make it through the day).
• MAKING ENVIRONMENTAL MODIFICATIONS
• Modification and organization of the environment
  in order to decrease stress on a fragile sensory
  system.

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Those with sensory processing challenges

• May not be able to filter and focus
• May attempt to adjust in a
  maladaptive way
• (Ex Escalation of Mood,
  Shutting Down)
• Will require a sensory diet enriched with
  unique sensations and experiences

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Creating The Sensory D.I.E.T.

• D ..Do an Informal Assessment
• I ..Individualize
• E ..Environmental Supports
• T ..The Power Senses

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Do an Informal Assessment

• Assess the Environment and the Individuals
  response to a variety of sensory experiences
• This is part of the FBA
• Seeker?
• Active Avoider?
• Under-Responder?
• Overwhelmed

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Individualize the Sensory Diet

• What has worked for one person may not work at
  all for someone else!

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Considerations for the Sensory Diet
SEEKER Provide sensory experiences frequently
proactively May need to limit excitatory
experiences
UNDER-RESPONDER Increase the use of visual
supports and routines. Structure the
environment. Time to respond Careful
encouragement to try new experiences
ACTIVE AVOIDER Modify the environment to reduce
the need to escape Gentle introduction to new
experiences
OVERWHELMED Control the environment Limit
stimulation Limit change but prepare for
changes when they need to occur.
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Environmental Supports

• These strategies
• can be used
• at any point.
• Antecedent
• Behavior
• Consequence

• Other People
• Organization
• Predictable, Structured, Consistent
  Environment
• Task or Curriculum
• Visual Supports
• Escape Environments

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The Power Senses
These strategies can be used at any point, but
are often most effective in the antecedent
phase As a preventative measure Allowing the
individual better problem solving skills

• Vestibular
• Movement
• Proprioception
• Input through
  joints and muscles
• Tactile
• Deep Pressure Touch

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• Why Focus on
• The Power Senses?

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Tofill the sensory bucket quickly use the
Power Senses

• Three Power Senses will provide
• more input
• more quickly
• to make changes that are more rapid

Sensory Bucket
Based on Work of Bonnie Hanshu www.sensoryprocessi
ng.com
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Proactively Schedule Sensory
Activities

• Use the Power Senses throughout the day in order
  to help a person
  alert, attend, act, and react
• Activities identified as necessary should be
  non-contingent on behavior!
• Additional activities or input may be needed
  based on the behaviors observed (assessment)

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The Power Senses
Tactile System
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Tactile System

• Pertains to the sense of touch
• Alerts to danger
• Gives body boundaries
• Helps provide a basis for body image

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Two Tactile Systems
Protective
Discriminative
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Protective System

• Activates Fight, Fright, or Flight
• Born with this system- Primal
• Stimulated by light touch, pain, temperature
• Processed through the emotional, excitatory
  portion of the limbic system
•  NOT a cognitive response

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Discriminative Pressure Touch

• Deep touch/pressure, and vibration
• Activates Parasympathetic System
• Calms and organizes
• Allows for more cognitive response
• Helps us learn and think

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Dysfunction of the Tactile System

• Distractibility
• Hyperactivity
• Over/Under Sensitivity
• Hyper-vigilant
• Inappropriate pain sensation
• Avoids getting hands dirty
• Difficulties with clothing/textures
• Avoids whole hand
• Disorganized when touched
• Intolerant of wearing glasses/hearing aide
• Difficulty with Social Space

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Tactile Defensiveness is when

• - Sensitive to light touch
• Touch causes difficulty
  organizing behavior and
  concentration
• Touch causes negative emotional responses
• Can become aggressive, if feeling threatened or
  stressed

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Interventions for Tactile Defensiveness

• Brushing Protocols
• Wilbarger Protocol
• PRR
• Brushing over arms, legs, back with a soft brush
  , followed by joint compressions
• Caution
• A brushing protocol should
  only be implemented after
  
  an assessment and training by a
  qualified professional

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Choose carefully..

• .But need this to avoid getting too high
• Safer for the Avoider-Overwhelmed
• Smooth/hard/squeezes leads to cognition/ calmness

• Seeker may want this.
• Better for the Under-responder
• Light Touch Excites!

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What Others Can Do

• Avoid unnecessary touch
  and Ask Permission
• Avoid touching face to gain attention
• Move slowly and
  provide Waiting Time-
  up to 10 seconds
• When touch is necessary, use
  Deep Pressure Touch

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Other Ideas

• Escape place
• In the classroom
• Available at all times
• Blankets, tight clothing?
• Hand Prep exercises
• Rub, squeeze
• Preferred seating
• Front? Back? End?
• Ample space
• Perhaps in a small space?..Perhaps NOT in a
  corner? Based on assessment.

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The Front Porch
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Quiet Sensory Area
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The Power Senses
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Proprioceptive System

• Muscles, joints, and tendons provide a
  person with a subconscious awareness of
  body position via the feedback
  from receptors in the muscles,
  tendons and joints

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Proprioceptive System

• Motor
  Planning
• Awareness of body
  without constant
  visual monitoring

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Calm Response
Decreases Excitability ("Brakes" Dopamine)
Recycles Serotonin in the Synapse
Proprioception
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Dysfunction of Proprioceptive System

• Clumsiness, a tendency to fall
• Lacks awareness of body position/odd posture
• Difficulty with small objects (buttons/ snap)

• Disorganized.. Materials Thoughts
• Poor or resistance to handwriting
• Eats in a sloppy manner
• Resists new motor movement activities

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Activities that Provide Proprioceptive
Input 

• Joint compression or extension
• Heavy work activities
• The larger the joint, the more proprioceptive
  input

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Many Ideas

• Anything that allow for joint extension or
  compression
• Lifting and carrying items
• Pushing carts and boxes and chairs
• Marching, walking, running, pacing
• Erasing the board, shelving books
• Stretching exercises, yoga

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Examples of Heavy Work

• Passive Joint Compressions
• Jumping/Trampoline
  (floor may be better..)
• Stacking Chairs
• Weight Lifting
• Bungee Cord on Chairs
• Chewing Gum
• Pretzel Hugs

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ALL will need environmental supports

• Organizational Supports
• Visual Supports
• Color coding
• Timers/Watches
• Written directions
• Written rule reminders

Under-Responders will need clear and noticeable
supports
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What Can Others Do

• Stay on schedule
• Pace language
• Use Concrete Language
• Use Wait Time

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The Power Senses
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Vestibular System

• The vestibular system refers to structures
  within the inner ear (the semi-circular canals)
• These structures detect movement and
  changes in the position of
  the head

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• The brain needs
  vestibular input in
  order to function
• Vestibular input
  provides the
  Strongest Sensation

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• Movement can change an individuals attention,
  arousal and alertness in the shortest period of
  time
• The effects from vestibular activities can last
  longer than any other input

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Hyper-sensitiveActive Avoider and Overwhelmed

• Fearful reactions to ordinary movement
• Apprehensive walking or crawling on uneven or
  unstable surfaces
• Seem fearful in open space
• Appear clumsy
• Want their feet on the ground!
• These folks need gentle experiences and support
  as they become more comfortable

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Hypo-sensitive Under-Responders and Seekers

• Seeker Actively seek and demonstrate a need for
  intense movement experiences (pacing, jumping,
  spinning, spinning objects)
• May include visual stim
• Be aware Seeker can become over-excited
• Needs monitoring
• Cap-off vigorous vestibular activity with
  proprioception (heavy work /joint compression)
• Under-Responder may need gentle encouragement to
  engage in movement

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Activities that Provide Vestibular
Input 

• Can either ALERT or CALM
• If Seeker/Avoider/Overwhelmed
• Need Linear, Calm, Slow, Controlled movement to
  Gain Attention (I.e. rocking chair movement)
• If Under-Responder
• Need CAREFULLY Offered Unpredictable,
  multi-directional, spinning (if individual
  requests) to alert the under-responder
• Be very cautious This type of vestibular
  movement can be very frightening

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Summary of Processing Challenges
SEEKER Heightened Awareness with Low Sensitivity
to Stimulation Will Seek Out Input (Frequently
and Intensively Moving, Jumping, Spinning,
Touching)
UNDER-RESPONDER Poor Awareness Low
Sensitivity to Stimulation. Misses Environmental
Cues Slow Processing (Acts as if does not hear,
misses gestures and cues, sedentary)
ACTIVE AVOIDER High Awareness, with High
Sensitivity and Active Responses. Will actively
avoid (Searching out Escape Areas, Covering
ears/eyes, Aggression to Protect self)
OVERWHELMED Heightened awareness, High
Sensitivity but lacks active response, Can
become easily overwhelmed. ( Complains of things
bothering Frequently anxious/upset, overreacts
to small changes in the environment)
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SEEKER Many implications to Antecedent
Triggers Provide sensory experiences frequently
proactively May need to limit excitatory
experiences
UNDER-RESPONDER Sensory interventions will
support and improve the effectiveness of all
other interventions Visual supports and
routines. Structure the environment. Time to
respond Careful encouragement to try new
experiences
ACTIVE AVOIDER Many implications to Antecedent
Triggers and Supporting Behavior Modify the
environment to reduce the need to escape Gentle
introduction to new experiences
OVERWHELMED Many implications to Antecedent
Triggers and Consequence Driven
Interventions Control the environment Limit
stimulation Limit change and prepare when they
need to occur.
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A Place To Start.

• Antecedent Measures
• Movement
• Frequent..throughout the day
• Some vigorous.some calming
• Heavy Work
• As part of the daily routine
• Personal Space and Tactile Support
• Available consistently
• Care when touching an individual
• Opportunities for calming touch

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A Place To Start.

• During an Incident
• Movement
• Allow safe movement
• Heavy Work
• If able to touch the individual, joint
  compressions can help calm and focus
• Personal Space and Tactile Support
• Do not touch or invade personal space
• This includes verbal invasion
• If able to touch, deep pressure calms
• Heavy blankets/pillows

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A Place To Start.

• Consequence Interventions
• During De-escalation
• Movement
• Allow safe movement
• Heavy Work
• Joint compressions can help calm and focus
• Personal Space and Tactile Support
• Do not touch or invade personal space
• Deep pressure calms
• Heavy blankets/pillows

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A Place To Start.

• Consequence
• Reinforcement Interventions
• Contingent on the demonstration of a targeted
  behavior or skill
• Caution Items in this category do NOT include
  those that have been defined as necessary (i.e.
  part of the sensory diet)
• Items in this category are additional, pleasant
  experiences that the individual enjoys, but does
  not require in order to focus and learn

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Example

• Using Sensory Experiences as Reinforcement in a
  Contingent manner
• NOTE The item used is NOT part of the Sensory
  Diet
• ABA and Sensory

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A Place To Start.

• Reinforcement Interventions
• Movement
• Enjoyable movement activities Trampoline,
  walks, sit and spin, swinging, etc.
• Heavy Work A job that the individual enjoys
• Personal Space and Tactile Support
• Time alone
• Variety of tactile items to explore
• Auditory/Visual
• Music
• Books, videos
• and many more.

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Post-Assessment

• More alert?
• More tuned in?
• Able to respond more quickly?
• Able to focus on task?
• Able to attend for longer periods?
• Calmer - Less explosive or unpredictable?
• More interactive?
• Less stressed?
•  

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Understanding the Impact of Communication in the
Classroom

• Denise Sawan Caruso, MA
• Speech/Language Pathologist
• Education/Parent Consultant

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• Even the most verbal individual with special
  needs has difficulty with some aspect of
  communication

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Neurological challenges will affect communication

• Slower processing time
• Difficulty shifting attention
• Difficulty filtering information affects
  processing multiple stimulus
• Difficulty with short term memory
• Difficulty building a rich receptive language
  vocabulary
• Limited expressive communication
• Verbal but inappropriate

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Specifically
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Challenges to receptive communication include

• Difficulty understanding word meaning(s)
• Concrete vs. Abstract
• Difficulty processing information
• Difficulty storing information
• Difficulty retrieving information
• Difficulty understanding multiple words together

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Challenges to expressive communication include

• Difficulty expressing needs, wants, desires
  accurately and appropriately
• Difficulty expressing inner language
• Inappropriate protesting
• Verbally
• Physically
• Difficulty asking for help
• Difficulty understanding social demands

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Adults interacting with individuals with special
needs should

• develop a variety of strategies that are used by
  all adults
• Consistently
• Frequently
• In all environments

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That is

• We need to change our communication behaviors
  and understand how to support communication with
  individuals who are communicatively challenged

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Healthy Communication Tools include the
following

• 1. One person talking at a time
• 2. Protocols
• 3. Maintaining eye contact
• 4. Waiting time

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• 5. Decreasing question asking
• 6. Increasing commenting/describing
• 7. Use what to do words
• 8. Provide substitute/replacement communication

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• 9. Understanding how and why to negotiate
• 10. Use statements with embedded choices to
  replace question asking with embedded choices
• 11. Choice making

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• 12. Acknowledgement of feelings
• 13. Freeze Frame Face
• 14. Visual Supports

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1. One Person Talking at a Time
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One Person Talking at a time (cont) IN THE
CLASSROOM

• Directions/instructions should be first initiated
  by one adult (usually the teacher (general
  education or resource room) or family member
• It it is the teacher
• Supports individuals awareness of role of the
  teacher
• Reduces sensory overload
• All other adults in classroom remain verbally
  quiet
• Other adult in classroom prepares visual supports
  based on teacher direction/instruction
• Written
• Other visuals
• Teacher/paraprofessional develop a sign/gesture
  to indicate when help is needed
• Used when additional support for individual is
  needed
• Should be part of Plan for Independence
• To reduce auditory distractions
• To develop attention to adult(s)
• To support the teachers role in the classroom

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One Person Talking at a time (cont) AT HOME

• If it is a family member
• Provide individual with one person to focus their
  attention
• Reduce multiple input from too many adults (or
  siblings)
• Give clear message of what to do
• Begin to develop safe person

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2. Developing Protocols
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Developing Protocols (cont.)

• Helps to establish eye contact
• Helps to ensure attention to person and/or task
  and activity
• Decreases speed of adult interactions

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I. Protocol for Interactions(for individuals who
actively avoid interactions with others)

• Be conscious of social distance
• Limit body movements
• hands behind back
• hands down at side
• Use soft, calm and even voice
• Introduce self by name
• Tell individual why you are there and what you
  are going to do
• commenting/describing
• Wait ten seconds for response before further
  interaction
• Responses verbal, eye contact, body/facial
  gestures

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II. Protocol to Gain Attention

• 1. Position self at childs eye level
• 2. Say childs name
• First and/or last name
• 3. Wait ten seconds
• If individual responds, move to Protocol when
  giving directions/instructions/requests/asking
  questions

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Protocol to Gain Attention (cont)

• If child does not respond..
• Repeat steps 1 through 3 only one more time
• If the individual does not respond add either a
  visual support or a sensory support

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• Visual support can include
• Object toy or object of interest
• Photograph of child
• Picture/icon of boy or girl
• Written childs name
• Sensory support can include
• Tactile deep pressure touch
• Auditory tapping visual support
• Visual a gesture

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How do you determine which protocol to use?...

• Know the individuals abilities
• - strengths
• - challenges

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How do you know when to add additional
supports?...

• Use the two direction rule
• - present information only two times

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III. Protocol When Giving Directions/Instructi
ons/Making Requests/Asking Questions

• Once attention is gained
• Get eye level
• Give direction/instruction/request/ask question
• Wait Ten Seconds
• No responserepeat one more time
• No responseCHANGE or ADD
• Verbal interaction style
• Words
• Rate and vocal quality
• vocabulary
• Visual support (object,photo,picture/icon,written)
  
• Gesture
• Rhythm/Music
• Sensory Supports
• Environmental Stimuli
• FINALLY, reevaluate what you are asking the
  individual to do

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• Is the task/activity (curriculum) too hard, too
  easy, too repetitive, too boringin other words
• Not meaningful, relevant, useful, purposeful or
  functional

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3. Maintaining Eye Contact During
Interactions/Activities
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Maintaining eye contact during interactions/activi
ties

• Wait for visual acknowledgement before continuing
  to present verbal information
• Move on with an activity only if individual is
  attending to that activity
• Using hand-over-hand support
• Position yourself at the individuals eye level
• Stop the activity until the individual is
  looking/attending to the activity

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4. Waiting Time
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Waiting Time

• Assess how long individual needs to process
  information
• Based on assessment, determine length of waiting
  time between directions, instructions, making
  requests and asking questions
• Share waiting time with all adults working with
  student
• Develop a sign/gesture for adults as a reminder

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5. Decrease Question Asking
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Decrease Question Asking (cont.)

• Questions challenge individuals language
  abilitiesaffecting both
• Receptive language
• Expressive language

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Paired with
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6. Increasing Commenting/Describing
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Increasing Commenting/Describing (cont.)

• Provides verbal information on what is
  happening describe
• Environment
• Other's Actions
• Others Emotions
• The Individual's Actions
• The Individual's Emotions
• 80 commenting/describing20 question asking

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7. Use what to do words
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Use what to do words (cont.)

• Supports development of receptive language
• Ensures that individual understands what to do
• Replaces (or adds to) stop/no words

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Be sure to pair what to do language with

• visual supports
• ensures that individual understands what to
  do
• doesnt just rely on verbal information

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Examples of what to do using visual supports
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Very simple visual support to help a person to
remember what to do.
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Used as a handle to move the arrow
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Rules of the Room

• also provide what to do

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8. Use statements with embedded choices vs.
question asking with embedded choices
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Use statements with embedded choices vs. question
asking with embedded choices

• Provides individual with control
• Use when there isnt a choice
• Example
• You can do (this) or (this), choose one
• vs.
• Do you want to do (this) or (this)?
• Watch yes/no questions
• When there isnt a choice, dont create one
• If you use a yes/no question, respect the
  individuals answer

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9. Understanding How and Why to Negotiate
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Understand how and why to negotiate (cont)

• Negotiating is a give and take between the
  adult and the individual with special needs
• Determine what is most important to you
• Completing a task/activity correctly or
  participating independently on whatever the
  individual can do themselves?
• Adult taking control or individual taking
  control?
• Meltdown or learning how to manage my
  emotions/body?

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10. Provide substitute/replacement communication
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Provide substitute/replacement communication
(cont.)

• Replaces inappropriate communication with
  appropriate communication
• Replacement behavior should be close to
  inappropriate communication behavior

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Examples of replacement behaviors

• Child pinches to get attention
• Replacement behavior
• Child learns to gently touch arm or adult/peer
  when needs attention
• Child bites hand when doesnt get what he/she
  wants
• Replacement behavior
• Child learns to shake head no
• Child recites movies when frustrated
• Replacement behavior
• Child learns to make choice of what to do when
  presented with a visual choice board

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11. Choice making
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Choice making (cont.)

• Empowers individuals communication
• Provides individual with control
• Reduces potential meltdowns

152
Examples of

• choice making using visual supports

153
A simple folder with photos of activities that
can be done after school is used as a choice
support at home.
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This is the front of the Choice Board. It is in a
plastic sleeve.
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This is the back of the choice board. This was
created for use at home.
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Use of choices within a schedule format
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12. Acknowledgement of feelings
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Acknowledgement of feelings (cont.)

• Pairs words with action
• Supports emotional expression (no matter how
  inappropriate)
• Identify
• Emotion
• How you know
• Why
• Example I know you are mad. You are hitting
  me. You want to go outside. or You are happy.
  You are smiling. You love to play with your
  truck.

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Add visual supports

• with words

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Using a wheel to indicate feelings
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Strategy to support expressing emotions
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Cards on tongue blades to express emotions
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Teaching emotions

• using photos

180
Teaching a student how to imitate or mimic
emotions using photos
Emily surprised
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Emily happy
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Emily mad
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Another way for an individual to learn how to
express emotions

• using questions

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Notice the photos
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Is he tired?
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13. Freeze Frame Face
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Freeze Frame Face (cont.)

• Assists individuals understanding of emotions by
  stopping the face when using emotion words
• Facial expression(s) may be confusing and/or
  difficult to read

193
14. Visual Supports
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What are Visual Supports?

• Visual Supports provide opportunities for
  increased independence to
• Learn more quickly
• Decrease aggression/frustration/anxiety
• Increase receptive/expressive communication
• Make choices
• Complete tasks
• Cope with changes
• Transitions

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Visual Supports (cont.)

• Read facial/bodily gestures
• Learn organizational skills
• Understand/interpret information
• Increase social awareness/understanding
• Access general education curriculum

196
Visual Supports allow individuals to better
understand

• What to do
• What will happen
• When and where activities will occur
• People locators
• Complete tasks/activities
• How and when to transition
• What and how to make choices
• How to express emotions
• How to socially interact

197
Visual Supports

• Develop and implement visual supports -
• Frequently
• Consistently
• Throughout the day
• By all adults

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Visual Supports

• Visual Schedules
• Routines of the day
• Activity Schedules
• Breaks down a task/activity
• Choice Boards
• Provides communication support
• Gives individual control by making choices
• Rules of the Room
• Provides specific information on daily
  expectations
• what to do

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Examples of

• VISUAL SCHEDULES

200
Main Schedules
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Middle School Main Schedule
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Daily Schedule presented in complete sentences
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Visual Schedule indicating time (both digital
and analog)
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Another example - daily schedule presented one
week at a time
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Individual Visual Schedules
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Portable Picture Schedule
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This schedule was attached to the desk with
Velcro and had an envelope with extra pictures
attached to the back of the stand.
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Visual Supports placed in front of students desk
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Envelope at bottom of the Visual Schedule
212
Marks Workstation Schedule
Sensory Break included in the mini-
schedule
Use of a mini-schedule at a workstation will
assist a student to independently complete
activities
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The schedule offers the choice of writing answers
or using a computer to complete work
Mini-Schedule to show what steps are needed
OR
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Portable clipboard
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mini Picture Library inside clipboard
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Examples of

• ACTIVITY SCHEDULES

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Visual Schedule for specific activities done on a
daily basis
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Activity Schedules for

• specific activities

223
Added photos
224
Visual Sequence of an Activity showing all
steps Dont forget to show all steps
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Mini-Schedule for John on Tuesday
Mini-Schedule showing what is needed in each class
Main Schedule
Paints Brushes Art Paper
Need
Notebook P-Touch
Coin-u-lator Lunch Money Pencil Notebook
Tennis Shoes Gym Shorts
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A mini-schedule to provide Mary with exactly what
she is expected to do in art class and
what to do at the end of the
class, before the next scheduled class
Marys Schedule

• Teacher Talk
• Finish Painting Clay Pot
• Wash brushes and table
• Do Find the Hidden Picture

227
Activity Schedule using - First Then Now
Next Finally
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written directions
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Student in Workout Room with written supports
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Examples of written supports
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Task Organizers
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Used for activities that occur daily
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Adolescent Work Activity Schedule
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Examples of

• MISCELLANEOUS VISUAL SUPPORTS

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Preschool activityAnswering wh questions and
supporting reading
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Example of Stop-Think
249

• Or

250
Example of Stop-Think with relaxation
strategies
251
Social Turn Taking
252
Social Turn Taking (close up)
253
Social Turn Taking (close up)
254
Social Turn Taking (close up)
255
Social Turn Taking
256
Use for turn taking and/or whose turn is it to
talk?
257
Golden Rules for the classroom
258
Finally
259
15. Hows it Working for You - Dr. Phil

260
Determine

• Are you implementing strategies too long???
• or
• Are you not giving strategies enough time???

261
Hows it Working for You (cont)

• Ask yourself the questions
• Is what you are doing working?
• Are you seeing changes in the individual?
  (appropriate or inappropriate?)
• Is the individual frustrated?
• Are you frustrated?

262
Results of FBA
Behavior of Concern
Function of Behavior

• Replacement Skills to Teach
• Equivalent Skills
• Related Skill

263
Observations and Strategies
Antecedents
Consequences
Setting Events/ Slow Triggers
Behavioral Event
Observations
Strategies
264
Results of FBA
Behavior of Concern Bolting from the Group
Function of Behavior

• Replacement Skills to Teach
• Equivalent Skills
• Related Skill

265
Observations and Strategies
Antecedents
Consequences
Setting Events/ Slow Triggers
Behavioral Event

• Lack of predictability during transition
• Frequent and numerous verbal instruction
• Presentation of academic task
• ---------------------------------

• Multiple adult attention
• Multiple questions (whys and should haves)
• Short Break before returning to classroom
• Removal of demands or assistance to complete
  tasks
• ---------------------------------------

• Frequent and loud DONT RUN , etc.
• Chasing, running
• Additional staff turning attention to student
• ------------------------

• Disorganized/ unstructured classroom
• Lack of understanding of schedule
• Long periods of time sitting
• -------------------------------

266
Results of FBA
Behavior of Concern Bolting from the Group
Function of Behavior Communication Avoid/Escape
Attention-Seeking

• Replacement Skills to Teach
• Equivalent Skills
• Ask for Help
• Ask for a Break
• Request an Interaction
• Related Skill
• Development of the missing academic/functional
  skill

267
Observations and Strategies
Antecedents
Consequences
Setting Events/ Slow Triggers
Behavioral Event

• Lack of predictability during transition
• Frequent and numerous verbal instruction
• Presentation of academic task
• ---------------------------------

• Multiple adult attention
• Multiple questions (whys and should haves)
• Short Break before returning to classroom
• Removal of demands or assistance to complete
  tasks
• ---------------------------------------

• Frequent and loud DONT RUN , etc.
• Chasing, running
• Additional staff turning attention to student
• ------------------------

• Disorganized/ unstructured classroom
• Lack of understanding of schedule
• Long periods of time sitting
• -------------------------------

• Visual schedule to anticipate routine
• Visual directions/ instructions
• Visual choice of help and break
• Develop/adhere to daily routines
• Social Story/ Visuals to remind/prime how to
  request help/break
• Allow to transition first or last.space
• Pass out materials (directed movement) as class
  begin assignment - allows time for teacher to
  assist student to begin

• Limit adult interaction
• Limited or NO questions
• Provide visual supports of desired communication
  (I need help, I need a break)
• Respond to requests
• Laterreview , role play and reinforce the
  desired actions
• .And
• Develop a reinforcement program for successfully
  requesting help/break/social interaction
• Provide direct instruction in academic skills
• Reinforce attempts at task

• Provide visual schedule to anticipate routine
• Visual choice of specific activities while
  students arrive and organize for the day
• Classroom structure to support predictability
• Frequent movement and heavy work breaks,
  proactive, non-contingent

• Limit adult involvement
• Limit / Verbal Interaction
• Safety measures
• Provide space to run to..escape area within the
  classroom
• Set timer in the escape area, no discussion, no
  physical contact

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Now Your Turn!
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Link to video http//www.youtube.com/watch?vvfav
iuuOHuY
270
Results of FBA
Behavior of Concern When playing will line up
cars over and over Does not respond to adult
verbal attempts
Function of Behavior Communication Avoid/Escape

• Replacement Skills to Teach
• Equivalent Skills
• Communicate Leave Me Alone
• Choose a different way to escape or calm
• Related Skill
• Develop additional skills to play with cars
• or other toys on the shelf

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Observations and Strategies
Antecedents
Consequences
Setting Events/ Slow Triggers
Behavioral Event

• Extensive Verbal Requests to respond and React
• ---------------------------------

• Continued verbal input from adult
• Child continued with isolated play
• ---------------------------------------

• Lay down,
• Turn Over
• Turn Away
• Grabbed for more cars
• ------------------------

• Visual Distraction
• Auditory Distraction
• Verbal Distraction
• Dog (Olfactory?)
• -------------------------------

• Activity Schedule with pictures with different
  play steps with cars
• Choice board of two items to choose to play
• Reduce question asking
• Attention Protocol
• Mix in some deep pressure/ proprioception and/or
  movement as part of the play

• Allow to play alone for a short time after
  following adult plan for play (reinforcement)
• No Adult interaction
• No Adult requests
• Add some heavy pillows to play area
• Match pictures of toys to completed play
  activities
• Reinforcement choice board of next activity

• Remove auditory and extensive visual distractions
• Clean shelves
• Regularly scheduled play time
• Provide a visual calendar of daily playtime
• Proprioceptive and Vestibular input prior to
  playtime

• Increase commenting and describing
• Use what to do words with visuals
• Attention protocols
• Use a visual to request leave me alone
• Creating a token system that relates to each step
  of completed play
• Be cautious with too much touch or invasion of
  space
• Monitor readiness for touch

272
Link to video http//www.youtube.com/watch?vxn6u
vQMW4RQfeaturerelated
273
Results of FBA
Behavior of Concern When asked to eat he
protests by verbally saying no, making up
words, laughing, getting out of seat, hitting mom
Function of Behavior Communication Avoid/Escape
Attention-getting

• Replacement Skills to Teach
• Equivalent Skills
• Communicate I am full
• Choose a different way to get attention
• Related Skill
• Teach how to provide additional verbal
  information
• related to why he is full or wants to
• escape (Theory of Mind)

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Observations and Strategies
Antecedents
Consequences
Setting Events/ Slow Triggers
Behavioral Event

• Confusing verbal directions and requests from
  mother
• Physical contact -------------------------------

• Mother continued confusing verbal input
• Changed number of bites
• Didnt observe childs behavior (two bites)
• A series of events that resulted in different
  observations, such as -
• Child leaves
• Compliant
• Verbalized accurately his behavior
• ---------------------------------------

• Varying responses -
• Verbalized no
• Got silly
• Jumped out of chair
• Hit mother
• Left kitchen
• Laughed
• Played with bottle
• Ignored food
• Mother continued confusing verbal input
• ---------------------------

• Ate a big lunch
• Lack of communication between adults
• --------------------------------

• Limit verbal directions
• Keep verbal directions concrete and clear - what
  to do words
• Use visuals to support prior meal behaviors
• Provide some choices of what to do in place of
  eating now (negotiation)
• Avoid close physical contact
• Providing small portions (or bites) of food
  presented at one time

• Parents communicate prior to next meal
• Provide a daily menu plan
• Check what he eats at each meal
• Teach child how to tell adult about prior events
  that have occurred, ie. during meal time
• Monitor childs ability to tolerate eating
  preferred foods due to modulation issues

• Reinforce for appropriate verbalizations
• Review and check off items on menu plan
• Review and practice replacement responses to use
  when asked questions about meal time

• Adult needs to stop talking
• Use visual supports to guide child
• Review menu
• Use commenting and describing
• Have meals together